- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $10,471.29 / $18,197.01
| Facility | | $5,623.41 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $23,442.29 / $44,668.36
| Facility | | $4,365.16 | $23,442.29 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $3,548.13
| Facility | | $891.25 | $891.25 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | AS | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $4,897.79
| Professional | | $3,715.35 | $3,715.35 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $4,677.35
| Facility | | $2,041.74 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $22,387.21 / $37,153.52
| Facility | | $8,317.64 | $22,387.21 | $37,153.52 |